Social Determinants of Health, Mental Health, and Cognitive Function in Older Adult ICU Survivors

Introduction: Social determinants of health (SDoH), such as social vulnerability and neighborhood deprivation, can negatively impact mental health and cognitive function in older adults following ICU hospitalization, contributing to inequities in long-term outcomes. We explored associations between SDoH, mental health, and cognitive function in older adult ICU survivors during the early post-ICU transition period.


Methods: We conducted a secondary data analysis of baseline data on variables of interest collected from older adult ICU survivors enrolled in two ongoing clinical trials. We examined social vulnerability using CDC Social Vulnerability Index (SVI) coefficients; SVI levels were categorized as low, low-medium, medium-high, and high. We measured patient-reported mental health with PROMIS Depression and Anxiety T scores; higher T scores indicated worse symptoms. We assessed cognitive flexibility using the Oral Trail Making Test (OTMT) completion time in seconds, where longer times denoted worse cognitive impairment. One-way between-subjects ANCOVA first examined the association between SVI level and OTMT completion time, co-varying out the effects of age and PROMIS Depression and Anxiety T scores. We then conducted multiple regression to predict OTMT completion time based on SVI coefficients, age, and patient-reported mental health symptoms.


Results: The main effects for SVI level [F(3,22)=3.25, p=.04, η²=.307] and depression scores [F(1,22)=15.67, p<.001, η²=.416] on OTMT completion time were significant, indicating that higher social vulnerability and worse depression were correlated with impaired cognitive flexibility. The regression model explained 46.7% of the variance [F(4,24)=5.25, p=.003, R²=.467] in OTMT completion time. Higher SVI coefficients (β=.410, t=2.50, p=.02) and worse depression scores (β=1.001, t=3.61, p=.001) significantly predicted impaired cognitive flexibility.


Conclusions: Our results suggest that depressive symptoms may be an early indicator of worse cognitive function in socially vulnerable older adult ICU survivors. Interdisciplinary collaboration (i.e., social work), is essential to identify and address SDoH. Further research should aim to develop personalized, multimodal interventions that target both mental health and SDoH for this clinically complex population.